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Myofascial Pain Syndrome

Myofascial Pain Syndrome. Vasu Kanjana-huttakit M.D. Orthopedic Surgery & Rehabilitation Vibharam Hospital. Muscle pain. Muscle spasm. involuntary contraction caused by trauma, excessive tension, organic disorder. Muscle tension. Prolonged contraction of a muscle cause by Postural tension

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Myofascial Pain Syndrome

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  1. Myofascial Pain Syndrome Vasu Kanjana-huttakit M.D. Orthopedic Surgery & Rehabilitation Vibharam Hospital

  2. Muscle pain

  3. Muscle spasm involuntary contraction caused by trauma, excessive tension, organic disorder

  4. Muscle tension • Prolonged contraction of a muscle cause by • Postural tension • Emotional tension • Situational tension

  5. Muscle deficiency • Inadequate muscular fitness to meet the requirements of activities of daily living

  6. Trigger point

  7. Etiology

  8. Epidemiology • Female > male • Prevalence 31-50 y • Axial, postural muscle groups • Most common cause of chronic pain • Latent trigger point > active

  9. Pathophysiology • Micro ,macro trauma • Disruption of sarcomere • Release of free calcium • join ATP to stimulate actin-myosin • Increase metb,serotonin,pg,kinin,His • Stimulate nociceptor..pain,refer pain • CNS stimulate muscle spasm

  10. Pathophysiology • Decrease blood flow, ATP ,calcium pump • Local fibrosis

  11. Most frequent locations

  12. Symptoms • Local & refer pain • Pain w contraction • Stiffness • Weakness • Paresthesia • Propioceptive disturbance • Autonomic dysfunction

  13. Physical findings • Local tenderness • Refer pain • Single or multiple muscle involvement • Palpable nodules • Firm or taut bands in muscle • Twitch response • Jump sign • Weak , shortening , limit motion

  14. Types of trigger point • Active vs Latent • Primary, secondary, satellite

  15. Trigger point

  16. Trigger point

  17. History • Systemic review • Trauma • Previous medical & surgical treatment • Chronic debilitating disorder • Endocrine disorder • Dental • Allergy

  18. History related to MPS • Characteristic of pain • Onset • Occupational activities • Athletic activities • Sleep problems • Psychological • Endocrine

  19. Physical examination • General • Posture & Movement • Muscle evaluation ROM flexibility strength spasm tension trp • Neurological exam

  20. Local tenderness, taut-band ,twitch ,jump sign Singular or multiple Any muscle Specific refer pain Autonomic & propioception symptoms Local tenderness Multiple Specific , symmetrical No refer pain Trigger points vs Tender points

  21. Trigger point palpation • Flat palpation • Snapping • Pincer or grasping

  22. Diagnosis Criteria (Yunus) • Major 5 1 regional pain 2 referred pain pattern of trigger point 3 taut band 4 hyperirritable spot in taut band 5 limit ROM

  23. Diagnosis Criteria (Yunus) • Minor 1 reproducible referred pain 2 local twitch response 3 release by stretching exercise or trigger point injection Diagnosis with all major and one of minor

  24. Spontaneous recovery Persistence without progression Additional trigger points and chronic Natural course

  25. Classification of MPS • Acute <2 m • Subacute 2-6 m • Chronic > 6 m

  26. Poor prognosis (chronic) • Unrecognized • Overlook • Improper treatment • Inadequate treatment

  27. Principle of MPS managemment • Trigger point management • Correct Perpetuating factors

  28. Injection Stretch and Spray Massage Heat therapy Acupuncture Electrotherapy Exercise Drug Trigger point management

  29. Perpetuating factors • Mechanical • Systemic • Psychological

  30. Trigger point injection • Local anesthetic agent • Steroids • NSAIDS • Saline • Distilled water • Botulinum toxin

  31. Mechanical -feedback disruption -release of intracellular K -wash out effect -focal necrosis Chemical -local vasodilatation -local anesthetic -focal necrosis Mechanism of injection

  32. Stage of recovery • Local anesthetic period ½ -1 hr • Post injection soreness 2-3 days • Migrating pain • Healing phase

  33. Complications • Internal organ injury • Pneumothorax • Pneumoperitoneum • Muscle injury • Nerve injury • Infection • Toxic , allergic

  34. Contraindications • Acute trauma • Bleeding tendency • Allergy • Infection • Pregnancy

  35. Inhibit pain gate Disruption of trigger point Restoration of normal length Stretch and spray

  36. Circulation Gate control Waste product removal Massage

  37. Stroking

  38. Stripping

  39. Kneading

  40. Friction

  41. Acupressure

  42. Precaution • Hyperirritable trigger point • DVT • Infection • CA • Skin disease • Personel

  43. Deep -ultrasound -short wave Superficial -hot pack -hydrocollator Heat therapy

  44. Thermal effect • Gate control theory • Endorphins • Increase pain threshold • Increase circulation • Sedation • Relaxing effect

  45. Contraindications • Impair sensation • Impair circulation • Bleeding disorder • CA • Acute inflammation

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